Emulsification of seman

Sensitive but not specific test for Prostate cancer

• If Negative: Can rule out
• If Positive: Can be other reason
  • Recent ejaculation
  • Infections
    • Prostatitis
    • Epididymitis/Orchitis
  • Long bike ride
  • Surgery
• Used for RISK instead of Diagnosis

Approach

• From peripheral zone
• Low risk: < 7, 6 or less -> active survellience (PSA and DRE annually)
• Intermediate risk: 10-20, glens score: 7 -> patient’s choice
• High risk: 20+, Gleason scores: 8+   -> treatment radical cystectomy
• PSA is a tool to assess the risk of prostate cancer, not marker of prostate cancer
  • Contraversy came from PLCO
  • New ESRPC trial shows that it is very cost-effective
  • Dx is often PSA-driven (DRE normal)
  • Cost-effective → ID indolent prostate cancer, once biopsied and confirmed, can send people for active surveillance program, to prevent radical therapy